All services integrated under one roof.

We believe in accountability for what we do. Predictive Health’s™ patent pending programs have integrated the medical management process to help employers improve health while controlling costs. A team of nurses and clinicians work directly with each client. Our direct patient interventions are coordinated by Certified Case Manager Nurses, with Physician oversight. 

Instead of hand-offs between different vendors, Predictive Health™ manages the entire medical management process for the client:

  • Utilization Management
  • Concurrent Review
  • Discharge Planning
  • Case Management
  • Disease Management
  • Technology and Specialty Pharmacy Management
  • Predictive Management

Managing the Costs of Technology and Specialty Pharmaceuticals

With the costs of specialty pharmaceuticals projected to reach $60Billion by the end of the decade, and new and costly medical technologies becoming available every day, what’s an employer to do?  Direct-to-consumer advertising and the Internet have brought information to the patient, but does the patient know enough to make the right decisions to improve their health?

Predictive Health™ takes a “wholistic” approach to each patient. Our access to technology assessments and evidence-based medicine reviews from medical specialty societies allow us to address the needs for the individual patient. When new technology or transplants becomes necessary, access to our centers of excellence networks help guide the patient to those centers with the best outcomes for care. 

Controlling Medical Costs-Root out Fraud and Abuse

Have you wondered what can be done about the company's rising health care costs? 97% of hospital bills have errors—with the vast majority not in your favor.  It’s one thing to have contracts with hospitals and providers for discounts off billed services. It’s another thing to make sure that the services were actually provided! You wouldn’t pay an invoice from any other vendor before making sure that the goods and services were actually delivered—so why would you pay health care claims simply upon presentation?

Predictive Health™’s analytic processes work with your third party payor to screen for fraud and abuse.  You shouldn’t pay for smoking babies, pregnant men, or open heart surgeries in an outpatient center. Employers and trusts need to remain aware and vigilant for hospital bills that are padded or have errors.

Predictive Health's™ takes the fraud and abuse analysis process one step further than the standard claims analysis that only focuses on unbundling of services. Our team of nurses and physicians scrutinize high-dollar hospital claims on a line-by-line basis to make sure that you are paying for services that were actually provided. This intensive analysis is something that cannot be provided by an automated system. Our goal is to make sure that you pay only for the services that were actually provided. Once inappopriate claims are eliminated, the third-party payor can then apply their network discounts to the corrected bill.

It’s Dollars and Sense

Managing health care is a full-time business for Predictive Health™. Our laser attention to detail allows your broker and third party administrator to work with insurers to obtain significant discounts on your stop-loss premiums. State-of-the-art forecasting through predictive modeling helps actuaries to set premiums appropriately. Early identification and management of patients that would otherwise incur high costs and hospitalizations helps prevent claims from becoming million-dollar babies. Our monitoring processes makes sure that patients are adherent and compliant with their medications. While medication compliance may cost a few dollars more in the short run, it will save you significant $$ over time compared to costly emergency room visits, hospitalizations, dialysis, blindness and other disabilities.

©2015 Predictive Health™, LLC